Dr. Muhammad Zohaib Siddiq
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 27-year-old female with a healthy BMI. Two years ago, at the age of 25, an ECG revealed early repolarization antero-laterally and inferiorly. Subsequent ECGs were normal, but I have been experiencing regular palpitations, and occasional lightheadedness when lying down or standing up quickly, and my resting heart rate, according to my fitness watch, ranges from 59 to 64.
My GP attributed the palpitations to anxiety, but I remain concerned given the mixed risk indication on my ECG report. The report mentioned "Sinus arrhythmia" with irregular p-wave duration but normal morphology of p-waves and stated that the p-wave duration was representative of atrial depolarization.
During the abnormal ECG, I was taking a high dose of Modafinil for ADHD, consuming stimulants like coffee and energy drinks, and experiencing heightened stress. Additionally, I received my third COVID-19 vaccine dose a few months earlier. Considering these factors, I am curious if they could have influenced the ECG reading. Moreover, I wonder if pericarditis, possibly triggered by the COVID-19 vaccine, might be a consideration.
I have requested a weekly monitor but have only received two additional ECGs, both of which were normal. Given the persistent symptoms and uncertainties surrounding the initial abnormal reading, should I be advocating for more comprehensive investigations beyond ECGs?
Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
Your lipid profile results (attachments have been removed to protect the patient’s identity) indicate normal levels. If you are experiencing palpitations exclusively upon transitioning from a lying position to standing, potential causes may include orthostatic intolerance, orthostatic hypotension, or orthostatic tachycardia. A tilt table test is recommended in such cases for an accurate diagnosis.
For intermittent palpitations, consider undergoing Holter monitoring to provide continuous insight into your heart's activity. It is worth noting that early repolarization is not typically associated with palpitations.
To rule out electrolyte imbalances as a potential cause of rhythm abnormalities, it is advisable to have your serum electrolyte levels checked. Kindly share your electrocardiogram (ECG) for further assessment. Additionally, please inform me if there is any family history of cardiac issues.
I hope this information will help you.
Thank you.
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Cardiology
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